Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria

Giorgio, Concetta Di; Provenzani, A; Polidori, Piera

doi:10.1007/s11096-016-0284-7

Cited by 36 publications

(24 citation statements)

References 14 publications

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“…Differences in study design and prescription habits may explain the high variability observed in prevalence rates. Despite the conventional problems of applicability of Beers criteria in Europe, the updated version of 2012 has been proven to be superior to STOPP by a study conducted in Spain [10], which has been reproduced by other studies [11, 20]. Consistently, the results obtained in our study show that the 2012 AGS Beers criteria are more effective in detecting PIMs than the original STOPP tool (37.3% vs 18.7%).…”

Section: Discussionsupporting

confidence: 86%

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

Blanco-Reina

García-Merino²,

Ocaña-Riola

et al. 2016

PLoS ONE

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Emerging and changing evidence made it necessary to update STOPP-START criteria, and version 2 was published recently. In this study the objectives were to determine the prevalence of potentially inappropriate medication prescribing (PIM) in primary care using STOPP versions 1 (v1) and 2 (v2), as well as 2012 AGS Beers criteria, and analyze the factors associated with inappropriate prescribing according to STOPP/START v2. A cross-sectional study was carried out including community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. This variable was measured using three tools: STOPP v1, 2012 AGS Beers criteria and STOPP v2. Similarly, the percentage of patients receiving at least one potential prescribing omission (PPO) was calculated using START versions 1 and 2. A total of 1,615 prescriptions were reviewed. The median number of medications per patient was 7.1 drugs (±3.8). The prevalence of elderly people exposed to polypharmacy (≥5 medications) was 72.9%, whereas 28.4% of the participants took ≥10 drugs regularly. PIM were present in 18.7%, 37.3% and 40.4% of participants, according to the STOPP v1, 2012 Beers criteria and STOPP v2, respectively. According to STOPP v2, the number of medications taken (OR: 1.14, 1.06–1.25), the presence of a psychological disorder (OR: 2.22, 1.13–4.37) and insomnia (OR: 3.35, 1.80–6.32) were risk factors for taking a PIM. The prevalence of PPOs was 34.7% and 21.8% according to version 1 and 2, respectively. In conclusion, STOPP-START criteria have been remarkably modified, which is evidenced by the different prevalence rates detected using version 2, as compared to version 1. In fact, the level of agreement between version 1 and the updated version is only moderate. Special attention should be paid on benzodiazepines, which keep being the most frequent PIM.

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Section: Discussionsupporting

confidence: 86%

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

Blanco-Reina

García-Merino²,

Ocaña-Riola

et al. 2016

PLoS ONE

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“…‘Fragmentation of care’ and involvement of more than one prescriber increase the number of medications on a patient’s list [30]. Hospitalizations may increase the number of PIMs [51] too. Our research and other studies show that GPs sometimes do not dare to change/discontinue medications prescribed by a specialized physician in a hospital [37, 52] or in the ambulatory setting [14, 16].…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients—A qualitative interview study with GPs (CIM-TRIAD study)

et al. 2017

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BackgroundPotentially inappropriate medication (PIM) is defined as medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners’ views on PIM and aspects affecting the (long-term) use of PIM.MethodsAs part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development.ResultsThe majority of the general practitioners were not aware of the PRISCUS list. Agents deemed potentially inappropriate from the general practitioners’ point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring.We identified prescription- (e.g. benzodiazepines on alternative private prescription), medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. “demanding high-user”, positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM.ConclusionsWhile the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of medication reviews, “positive lists”, adequate patient information, multifaceted interventions and improved communication between general practitioners and specialists.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0595-3) contains supplementary material, which is available to authorized users.

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“…Multidisciplinary Medication Reviews or Interdisciplinary Ward Rounds ("Team Rounds") Such programs have been shown to decrease inappropriate medication use among nursing home residents, [13][14][15][16][17][18][19][20][21][22][23][24] particularly for patients whose medication loads have increased over time 25 and those transitioning to nursing homes. 26 We developed a guideline for conducting Team Rounds, the English version of which is available in Supplementary Appendix S1.…”

Section: Tool Selectionmentioning

confidence: 99%

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

Weeks

Mishra

Curto³

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE In nursing homes across the world, and particularly in Spain, there are concerns that psychotropic medications are being overused. For older Spanish nursing home residents who had dementia, we sought to evaluate the association between applying interventions designed to reduce inappropriate psychotropic medication use and subsequent psychotropic use. DESIGN Retrospective, propensity score–matched, controlled, patient‐level observational analysis. SETTING A total of 45 nursing homes in Spain. PARTICIPANTS A total of 1653 nursing home residents, aged 70 to 99 years, who had dementia and were prescribed an antipsychotic, anxiolytic, or antidepressant medication, 606 of whom received an intervention; the remainder served as propensity score–matched controls. INTERVENTION Team Rounds, Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria, or a Patient Decision Aid. MEASUREMENTS At 2 and 4 weeks following intervention: change from baseline drug class–specific milligram‐equivalent daily dose (MEDD); at 2 weeks: patient falls and restraint use. RESULTS Within each intervention/drug‐class cohort, intervention patients and matched controls had similar baseline demographic characteristics, Charlson scores, lengths of admission, and drug class–specific MEDDs. Compared to controls, patients exposed to Team Rounds experienced a 23.3% (95% confidence interval [CI] = 13.9%‐32.8%) reduction in antipsychotic and a 23.1% (95% CI = 18.3%‐28.0%) reduction in anxiolytic MEDDs; those exposed to Patient Decision Aids had a 24.8% (95% CI = 15.6%‐33.9%) reduction in antipsychotic and a 31.8% (95% CI = 25.5%‐38.2%) reduction in anxiolytic MEDDs; and those exposed to STOPP/START application had a 27.7% (95% CI = 22.4%‐33.0%) reduction in antipsychotic and a 39.5% (95% CI = 35.5%‐43.5%) reduction in anxiolytic MEDDs. Intervention‐associated antidepressant MEDD reductions were statistically significant but less dramatic. Interventions were associated with higher rates of medication discontinuation, but not higher rates of deaths, patient falls, or physical restraints. CONCLUSION We found strong evidence that the interventions we studied were associated with reduced psychotropic use without commensurate harms, suggesting that such interventions should be incorporated into Spanish nursing home care models. Public reporting of psychotropic medication use in Spanish care homes may encourage care homes to regularly monitor psychotropic medication use and implement such instruments. J Am Geriatr Soc, 2019.

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Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria

Cited by 36 publications

References 14 publications

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

General practitioners’ views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients—A qualitative interview study with GPs (CIM-TRIAD study)

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

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